Letter. Comparison of cataract surgery in a base hospital and in peripheral eye camps
Probably no-one will question the advantages of affordable good quality IOL surgery through satellite hospitals, near to where the patients live. The article by Gogate and Kulkarni illustrates the differences in results between hospital based surgery (ECCE/IOL and ECCE) and eye camp surgery (ICCE), in a large series.
The article states that final corrected visual acuities were much better in the Base Hospital (82.7% > 6/18), compared to the Peripheral Eye Camps (43.7% > 6/18). This statement, although clearly accurate in itself, does not seem to me to reflect possibly better results and conclusions – if some of the following comments had been considered and implemented.
In the Camps, visual acuity was assessed with standard +10D aphakic correction. It is reported that 99.1% of the patients received standard +10D aphakic spectacles after 6 weeks.
At the Base Hospital, retinoscopic refraction was done in 63.9% of the patients. This does not necessarily mean that patients also bought the spectacles according to prescription! Visual acuity is not known in the remaining 36.1%.
For comparison, it would have been better to either present visual acuity at the Base Hospital with IOL implant, without additional refraction (real life situation), or with standard +10D in aphakics, or to present retinoscopic refraction in both Camp and Base hospital for all patients. With additional retinoscopic refraction, the Camp group might well have had equally good visual results.
Poor visual results between both groups are about equal: 6/60 or worse at Camps in 5.1% and at Base Hospital in 6.1%. Vitreous loss was more often a complication in the Hospital, but the Hospital operated on more difficult cases.
In addition, 58.2% of the patients at the Base Hospital received an IOL. Thus, 41.8% were left aphakic. In combination with the poor follow-up, some of the aphakic patients may not have received any correction at all, resulting in a VA < 3/60, but no details are given of this group.
IOLs have become much cheaper since the study was done, but it should be noted that, at the time of the study, the main reason (80%) for not receiving IOLs, was inability to pay.
Another interesting point is that Camps were especially suitable for women, who often cannot travel far. This is an important factor that has to be taken into account.
The above study shows that Camps still have a role to play in remote rural areas and that results can actually be quite satisfactory.